Individual and medical characteristics of adults presenting to an urban emergency department in Ghana

Background: The aims of this study were to characterize the patients seeking acute care for injury and noninjury complaints in an urban Emergency Department in Ghana in order to 1) inform the curriculum of the newly developed Emergency Medicine resident training program 2) improve treatment processes, and 3) direct future community-wide injury prevention policiesStudy Design: A prospective cross-sectional survey of patients 18 years or older seeking care in an urban Accident and Emergency Center (AEC) was conducted between 7/13/2009 and 7/30/2009. Questionnaires were administered by trained research staff and each survey took 10-15 minutes to complete. Patients were asked questions regarding demographics, overall health and chief complaint.Results: 254 patients were included in the sample. Participants’ chief complaints were classified as either medical or injury-related. Approximately one third (38%) of patients presented with injuries and 62% presented for medical complaints. The most common injury at presentation was due to a road traffic injury, followed by falls and assault/fight. The most common medical presentation was abdominal pain followed by difficulty breathing and fainting/ blackout. Only 13% arrived to AEC by ambulance and 51% were unable to ambulate at the time of presentation.Conclusion: Approximately one-third of non-fatal adult visits were for acute injury. Future research should focus on developing surveillance systems for both medical and trauma patients. Physicians that are specifically trained to manage both the acutely injured patient and the medical patient will serve this population well given the variety of patients that seek care at the AEC.Keywords: Emergency Medicine, Injury, Surveillance, Ghana, Characteristic

Assessment of emergency medical services in the Ashanti region of Ghana

Background: We aimed to assess the structure, function and performance of Ashanti Region’s emergency medical services system in the context of the regional need for prehospital emergency care.Design: A mixed-methods approach was employed, using retrospective collection of quantitative data and prospectively gathered qualitative data. Setting – pertinent data were collected from Ghanaian and international sources; interviews and technical assessments were performed primarily in the Ashanti Region of Ghana.Participants: All stakeholders relevant to emergency medical services in the Ashanti Region of Ghana were assessed; there was a special focus on National Ambulance Service (NAS) and Ashanti Region healthcare personnel.Intervention: This was an observational study using qualitative and quantitative assessment techniques.Main outcome measures: The structure, function and performance of the Ashanti emergency medical services system, guided by a relevant technical assessment framework.Results: NAS is the premier and only true prehospital agency in the Ashanti Region. NAS has developed almost every essential aspect of an EMS system necessary to achieve its mission within a low-resource setting. NAS continues to increase its number of response units to address the overwhelming Ashanti region demand, especially primary calls. Deficient areas in need of development are governance, reliable revenue, public access, community integration, clinical care guidelines, research and quality assurance processes.Conclusions: The Ashanti Region has a growing and thriving emergency medical services system. Although many essential areas for development were identified, NAS is well poised to meet the regional demand for prehospital emergency care and transport.Keywords: EMS, prehospital, ambulance, emergency, Ghana, Afric

Assessing the genetic diversity of 48 groundnut (Arachis hypogaea L.) genotypes in the Guinea savanna agro-ecology of Ghana, using microsatellite-based markers

Groundnut (Arachis hypogaea L.) is the most important grain legume in Ghana. However, its production is constrained by a myriad of biotic and abiotic stresses which necessitate the development and use of superior varieties for increased yield. Germplasm characterisation both at the phenotypic and molecular level is important in all plant breeding programs. The aim of this study was to characterise selected advanced breeding groundnut lines with different phenotypic attributes at the molecular level using simple sequence repeats (SSR) markers in Ghana. A total of 53 SSR markers were screened and 25 were found to be polymorphic with an average polymorphic information content (PIC) value of 0.57. Of the 48 groundnut genotypes studied, 67% showed very close relationship (~100% similarity) with one or more genotypes among themselves. In fact, there were 14 instances where two to three genotypes within the same sub-cluster exhibited 100% similarity even though they displayed different phenotypic attributes. The remaining 33% of the groundnut genotypes were distant from each other and could therefore serve as effective parental material for future work. In this study, the SSR-based markers were found to be quite discriminatory in discerning variations between and among groundnut lines even where the level of variation was low. Microsatellite-based markers therefore represent a useful tool for dissecting genetic variations in cultivated crops, especially groundnu

Genetic diversity and population structure of groundnut (Arachis hypogaea L.) accessions using phenotypic traits and SSR markers: implications for rust resistance breeding

Groundnut (Arachis hypogaea L.) is a multi-purpose legume serving millions of farmers and their value chain actors globally. Use of old poorperforming cultivars contributes to low yields (\1 t/ha) of groundnut in sub-Saharan Africa including Tanzania. The objectives of this study were to determine the extent of genetic variation among diverse groundnut collections using phenotypic traits and simple sequence repeat (SSR) markers to select distinct and complementary genotypes for breedin

Can birth outcome inequality be reduced using targeted caseload midwifery in a deprived diverse inner city population? A retrospective cohort study, London, UK.

Objectives(1) To report maternal and newborn outcomes of pregnant women in areas of social deprivation in inner city London. (2) To compare the effect of caseload midwifery with standard care on maternal and newborn outcomes in this cohort of women.DesignRetrospective observational cohort study.SettingFour council wards (electoral districts) in inner city London, where over 90% of residents are in the two most deprived quintiles of the English Index of Multiple Deprivation (IMD) (2019) and the population is ethnically diverse.ParticipantsAll women booked for antenatal care under Guys and St Thomas' National Health Service Foundation Trust after 11 July 2018 (when the Lambeth Early Action Partnership (LEAP*) caseload midwifery team was implemented) until data collection 18 June 2020. This included 523 pregnancies in the LEAP area, of which 230 were allocated to caseload midwifery, and 8430 pregnancies from other areas.Main outcome measuresTo explore if targeted caseload midwifery (known to reduce preterm birth) will improve important measurable outcomes (preterm birth, mode of birth and newborn outcomes).ResultsThere was a significant reduction in preterm birth rate in women allocated to caseload midwifery, when compared with those who received traditional midwifery care (5.1% vs 11.2%; risk ratio: 0.41; p=0.02; 95% CI 0.18 to 0.86; number needed to treat: 11.9). Caesarean section births were significantly reduced in women allocated to caseload midwifery care, when compared with traditional midwifery care (24.3% vs 38.0%; risk ratio: 0.64: p=0.01; 95% CI 0.47 to 0.90; number needed to treat: 7.4) including emergency caesarean deliveries (15.2% vs 22.5%; risk ratio: 0.59; p=0.03; 95% CI 0.38 to 0.94; number needed to treat: 10) without increase in neonatal unit admission or stillbirth.ConclusionThis study shows that a model of caseload midwifery care implemented in an inner city deprived community improves outcome by significantly reducing preterm birth and birth by caesarean section when compared with traditional care. This data trend suggests that when applied to targeted groups (women in higher IMD quintile and women of diverse ethnicity) that the impact of intervention is greater

Hiv/Aids prevalence at the accident & emergency centre of a tertiary and referral health institution in Ghana

Background: Ghana has an estimated HIV prevalence of 1.4%, but the HIV prevalence of patients presenting at emergency departments in Ghana is not well documented in published literature. This study evaluated the prevalence of HIV infection at the Accident & Emergency Department, Komfo Anokye Teaching Hospital (KATH A&E), Kumasi, Ghana.Methods: A descriptive cross-sectional survey was carried out on patients aged 18 and above presenting to KATH A&E. An opt-in testing approach was used; consenting patients were screened for HIV using rapid HIV finger-stick testing with HIV 1-2 STAT-PAK. Sero-positivity was confirmed by OraQuick HIV 1-2 test. Data was analysed using multivariate logistic regression.Results: 1125 patients presenting at the KATH A&E during the study period were offered the Rapid HIV test. 667 of these patients consented to have the test. HIV prevalence was 13.5% (90/667). 53 females (58.9%) were HIV positive compared to 37 males (41.1%). The age group 30-50 years had the highest risk of being HIV-positive. Other socio-demographic variables such as educational level and occupation were significantly associated with HIV-infection (Pvalue = 0.001 at 95% CI).Conclusion: This study shows that emergency department HIV testing in Ghana is feasible. The prevalence of HIV sero-positive patients presenting at KATH A&E was tenfold higher than national estimates. We conclude that this study showed a high prevalence among patients seeking emergency care in our setting. Testing in the emergency department could lead to early detection of HIV-infected patients for linkage to care.Keywords: HIV Infections; HIV Screening; Prevalence, Diagnosis, Emergency Departmen

Dietary patterns in obese pregnant women; influence of a behavioral intervention of diet and physical activity in the UPBEAT randomized controlled trial.

BACKGROUND: Understanding dietary patterns in obese pregnant women will inform future intervention strategies to improve pregnancy outcomes and the health of the child. The aim of this study was to investigate the effect of a behavioral intervention of diet and physical activity advice on dietary patterns in obese pregnant woman participating in the UPBEAT study, and to explore associations of dietary patterns with pregnancy outcomes. METHODS: In the UPBEAT randomized controlled trial, pregnant obese women from eight UK multi-ethnic, inner-city populations were randomly assigned to receive a diet/physical activity intervention or standard antenatal care. The dietary intervention aimed to reduce glycemic load and saturated fat intake. Diet was assessed using a food frequency questionnaire (FFQ) at baseline (15(+0)-18(+6) weeks' gestation), post intervention (27(+0)-28(+6) weeks) and in late pregnancy (34(+0)-36(+0) weeks). Dietary patterns were characterized using factor analysis of the baseline FFQ data, and changes compared in the control and intervention arms. Patterns were related to pregnancy outcomes in the combined control/intervention cohort (n = 1023). RESULTS: Four distinct baseline dietary patterns were defined; Fruit and vegetables, African/Caribbean, Processed, and Snacks, which were differently associated with social and demographic factors. The UPBEAT intervention significantly reduced the Processed (-0.14; 95% CI -0.19, -0.08, P <0.0001) and Snacks (-0.24; 95% CI -0.31, -0.17, P <0.0001) pattern scores. In the adjusted model, baseline scores for the African/Caribbean (quartile 4 compared with quartile 1: OR = 2.46; 95% CI 1.41, 4.30) and Processed (quartile 4 compared with quartile 1: OR = 2.05; 95% CI 1.23, 3.41) patterns in the entire cohort were associated with increased risk of gestational diabetes. CONCLUSIONS: In a diverse cohort of obese pregnant women an intensive dietary intervention improved Processed and Snack dietary pattern scores. African/Caribbean and Processed patterns were associated with an increased risk of gestational diabetes, and provide potential targets for future interventions. TRIAL REGISTRATION: Current controlled trials; ISRCTN89971375

Mobility and Cognition in Seniors. Report from the 2008 Institute of Aging (CIHR) Mobility and Cognition Workshop

Background The annual Scientific Meeting of the Canadian Association on Gerontology was held on October 24 and 25, 2008 in London, Ontario. Prior to the annual meeting, mobility and cognition experts met on October 23, 2008 to engage in a pre-conference workshop. Methods Discussions during the workshop addressed novel areas of research and knowledge and research gaps pertaining to the interaction between mobility and cognition in seniors. Results Workshop presenters moved from the neuromuscular, biomechanics, and neurology of gait impairments, and falls through the role of cognition and mood on mobility regulation to the whole person in the environment. Research gaps were identified. Conclusions Despite a consensus that mobility and cognition are increasingly correlated as people age, several gaps in our understanding of mechanisms and how to assess the interaction were recognized. The gaps originally identified in 2008 are still pertinent today. Common and standardized assessments for “mobility and cognition” are still not in place in current practice. Interventions that target mobility and cognitive decline as a single entity are still lacking